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INTRODUCTION

This chapter provides “movie” image clips as they are viewed in clinical practice, as well as additional static images. Noninvasive cardiac imaging is essential to the diagnosis and management of patients with known or suspected cardiovascular disease. This atlas supplements Chap. 270e, which describes the principles and clinical applications of these important techniques.

FIGURE 271e-1

A 48-year-old man with new-onset substernal chest pain. Echocardiography shows evidence of acute anterior myocardial infarction involving the interventricular septum and apex secondary to an occlusion of the left anterior descending coronary artery seen from the parasternal long axis view (left) and the apical four-chamber view (right). LV, left ventricle; RV, right ventricle. (See Video 271e–1 and 271e-2.)

Video 271e–1 Echocardiography in the evaluation of acute myocardial infarction.

Video 271e–2 Echocardiography in the evaluation of acute myocardial infarction.

FIGURE 271e-2

A 55-year-old man with exertional chest discomfort and dyspnea. He exercised for 12 min on a standard Bruce protocol, experiencing typical chest pain and ST-segment depression in V2–V5. End-systolic frame of a stress echocardiogram shows apical four-chamber view at rest (left) and after exercise (right). After exercise, there is a clear regional wall motion abnormality in the distal septum through the apex, consistent with a stenosis in the left anterior descending artery distribution (arrows). LV, left ventricle. (See Videos 271e-3 and 271e-4.)

Video 271e–3 Stress echocardiography for suspected CAD.

Video 271e–4 Stress echocardiography for suspected CAD.

FIGURE 271e-3

Exercise single-photon emission computed tomography (SPECT) myocardial perfusion technetium-99m (99mTc) sestamibi scan in a 54-year-old male with a history of coronary artery disease and a prior coronary stent. The stress images (left and middle) show a large defect involving the apex, all apical segments, mid-inferior, mid-inferoseptum, and mid-anteroseptum (arrowheads), which is completely reversible at rest (right), reflecting a large area of exercise-induced myocardial ischemia throughout the left anterior descending coronary territory. The bull's eye displays on the right panel depict the semiquantitative extent of ischemia (light yellow and blue areas represent the extent and severity of ischemia).